TABLE 2.
Eligible Patient Age 75 Yr and Older | QI Recommended Care Process | Contraindications and Exclusions | Total Eligible (#) | Passed (#) | Passed (%) |
---|---|---|---|---|---|
Patient discharged from hospital | Follow-up appointment within 6 wk | – | 32,792 | 24,921 | 76.0 |
Patient with newly diagnosed dementia | Perform serum B12 & TSH level | – | 8889 | 665 | 7.5 |
Patient with newly diagnosed dementia | Receive cholinesterase inhibitor | – | 10,486 | 1387 | 13.2 |
Patient with dementia and new depression | Treat depression with pharmacologic therapy or mental health referral | – | 1178 | 235 | 19.9 |
Patient with new depression diagnosis | Treat with pharmacologic therapy or mental health referral within 2 wk | – | 3963 | 903 | 22.8 |
Patient newly treated with an antidepressant | Do not prescribe TCAs, MAOIs, benzodiazepines, or stimulants as 1st or 2nd line therapy | – | 694 | 619 | 89.2 |
Patient with coronary artery disease newly started on a TCA | Perform an ECG within 3 mo before initiation | Pacemaker | 70 | 30 | 42.9 |
Patient with depression changing from an SSRI to MAOI therapy | MAOI started a specified time after stopping SSRI | – | 5 | 4 | 80.0 |
Patient with depression changing from a MAOI to SSRI therapy | SSRI started a specified time after stopping MAOI | – | 34 | 11 | 32.4 |
Patient with diabetes | Perform a hemoglobin A1C at least every 12 mo | – | 26,494 | 11,195 | 42.3 |
Patient with diabetes without renal insufficiency | Perform an annual test for proteinuria | Receiving ACEI, ARB | 14,134 | 5068 | 35.9 |
Patient with diabetes | Eye examination every 2 yr | Blind | 23,380 | 12,026 | 51.4 |
Patient with diabetes and proteinuria | Prescribe ACEI or ARB | ACEI, ARB exclusions | 18,253 | 17,843 | 97.8 |
Patient with heart failure | Prescribe ACEI or ARB | ACEI, ARB exclusions | 37,177 | 17,749 | 47.7 |
Patient with new heart failure | Perform chest x-ray, ECG, CBC, serum electrolytes, and TSH | – | 11,226 | 3076 | 27.4 |
Patient with new heart failure | Evaluate left ventricular ejection fraction within 1 mo | – | 11,226 | 1585 | 14.1 |
Patient with heart failure | Prescribe a β blocker | β blocker exclusions | 14,927 | 3773 | 25.3 |
Patient with heart failure without atrial fibrillation | Do not prescribe 1st or 2nd generation calcium channel blocker | – | 22,433 | 21,843 | 97.4 |
Patient with heart failure | Do not prescribe a type 1 antiarrhythmic | ICD in place | 35,287 | 34,957 | 99.1 |
Patient with newly diagnosed hypertension | Perform ECG within 4 wk of diagnosis. | – | 16,200 | 5760 | 35.6 |
Patient with hypertension and renal insufficiency or proteinuria | Prescribe ACEI or ARB | ACEI, ARB exclusions | 16,515 | 6500 | 39.4 |
Patient with hypertension and asthma | Do not prescribe β blocker | – | 15,834 | 12,321 | 77.8 |
Patient hospitalized for AMI | Perform assessment of LVEF within 3 d of hospital discharge | – | 2580 | 1787 | 69.3 |
Patient with AMI or unstable angina | Perform stress test within 4 to 21 d | – | 2802 | 530 | 18.9 |
Patient with AMI or unstable angina and persistent ischemia | Perform cardiac catheterization | – | 5221 | 1628 | 31.2 |
Patient with known CAD and unknown lipids | Check lipids | – | 13,321 | 4140 | 31.1 |
Patient with CAD and hypercholesterolemia | Prescribe cholesterol-lowering medication | – | 36,363 | 17,308 | 47.6 |
Patient with history of AMI | Prescribe β blocker | β-blocker exclusions | 5260 | 1949 | 37.1 |
Patient prescribed warfarin | Check INR within 4 d of initiating medication and every 6 wk thereafter | – | 4218 | 3297 | 78.2 |
Patient prescribed thiazide or loop diuretic | Check electrolytes yearly | – | 40,866 | 35,631 | 87.2 |
Patient with diabetes | Do not prescribe chlorpropamide | – | 16,971 | 16,715 | 98.5 |
All patients | Do not prescribe medications with strong anticholinergic effects if alternatives are available | – | 100,528 | 84,248 | 83.8 |
All patients | Do not prescribe barbiturate medications | Seizure disorder | 95,639 | 92,387 | 96.6 |
All patients | Do not prescribe meperidine | – | 100,528 | 100,340 | 99.8 |
Patient prescribed ACEI or ARB | Check serum potassium and creatinine within 4 wk of initiation | – | 22,083 | 4779 | 21.6 |
Patient treated with warfarin, history of PUD or GI bleeding, AND treated with NSAIDS | Prescribe misoprostol or a proton pump inhibitor medication | – | 37,136 | 8735 | 23.5 |
Female patient newly diagnosed with osteoporosis | Prescribe bisphosphonates, SERM, calcitonin, PTH or HRT within 3 mo | – | 6678 | 2628 | 39.4 |
Atrial fibrillation in high risk patient | Prescribe anticoagulant | – | 20,370 | 4693 | 23.0 |
All patients | Perform eye evaluation every 2 yr | – | 76,804 | 37,118 | 48.3 |
Patient with open angle glaucoma | Perform comprehensive eye examination | – | 11,430 | 3653 | 32.0 |
Patient with diabetes and proliferative retinopathy | Perform dilated eye examination every 4 mo | – | 1487 | 319 | 21.5 |
Patient with macular degeneration | Perform dilated eye examination every 6 mo | – | 2300 | 888 | 38.6 |
Patient had cataract surgery | Perform follow-up ocular examination within 3 mo | – | 6971 | 1115 | 16.0 |
ACEI indicates angiotensin converting enzyme inhibitor medication; AMI, acute myocardial infarction; ARB, angiotensin receptor blocker medication; B12, vitamin B12; CAD, coronary artery disease; CBC, complete blood count; ECG, electrocardiogram; ECT, electroconvulsive therapy; GI bleeding, gastrointestinal bleeding; HRT, hormone replacement therapy; CD, internal cardiac defibrillator; INR, international normalized ratio; LDL, low density lipoprotein; LVEF, left ventricular ejection fraction; MAOI, monamine oxidase inhibitor; NSAID, nonsteroidal antiinflammatory drug; PPI, proton pump Inhibitor; PTH, parathryoid hormone; PUD, peptic ulcer disease; SERM, selective estrogen receptor modulator; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant; TSH, thyroid stimulating hormone.
Exclusions: β blocker, bradycardia, heart block, asthma, COPD, or β-Blocker intolerance; ACEI/ARB, renal artery stenosis, renal failure, hyperkalemia, angioedema, or ACEI/ARB intolerance.